I’d rather pretend MAID doesn’t exist. This article (National Post) emerged after MLI prodded me to consider it again. I did not receive payment, and MLI helped with editing.
Two radio interviews followed:
Nov 2, Roy Green Show
Nov 1, Afternoons with Rob Breakenridge (starts at 25:00)
Please follow this topic. It is painful, but MAID policy will impact your family at some point.
Thanks for taking a look!
There’s a big difference between what we imagine about Medical Assistance in Dying (MAID) in Canada and what actually happens to patients.
In 2015, the Supreme Court of Canada’s Carter decision overturned the ban on physician-assisted suicide and voluntary euthanasia for specific patients. The SCC cited “grievous and irremediable medical conditions” and “enduring suffering that is intolerable to the individual” as the criteria for obtaining MAID. The 2016 legislation that followed upon the decision required that death be “reasonably foreseeable.” But today, we see MAID offered proactively to vulnerable patients as part of the range of “treatment” options, and in situations where death is nowhere in sight. If we were first slipping down the terminal illness slope with increasing MAID usage, we’re now skiing down another hill altogether.
Leaving aside the inherently vague and non-medical nature of terms such as “intolerable suffering,” actual patient experience looks different than what the law suggests. Last week Canada made international headlines (again) after a 51-year-old woman in Nova Scotia was offered MAID twice during two separate pre-operative assessments for breast surgery, 15 months apart.
As reported in the National Post, Dr. Gus Grant, registrar and chief executive officer of the College of Physicians and Surgeons of Nova Scotia, said it was “clearly inappropriate and insensitive” for a doctor to raise MAID as a person was being rolled into a surgical suite. “I can understand why the patient was upset,” Grant said.
Similar cases abound: veterans offered MAID for PTSD, a Paralympian offered MAID after delays to get a wheelchair lift installed, a patient dying with “hearing loss” as their only reason for MAID, and a 41-year-old man receiving MAID for COVID “post-vaccination syndrome” — a debatable diagnosis.
In 2022, MAID was the sixth leading cause of death of death in Canada after cancer, heart disease, trauma, COVID and strokes. Absent COVID, MAID becomes fifth.
Dr. John Keown, professor of ethics at Georgetown University, argues Canada is “Skiing down euthanasia’s slippery slope.” We started by allowing voluntary euthanasia for terminal disease in adults and are now considering it for chronic disease and mental health issues, in some cases for children, too.
The slippery slope explains many things but leaves out too much. Slopes imply we have similar things along the slope. For example, terminal versus chronic disease, or physical versus mental suffering.
In Canada, we are way beyond slippery slopes. MAID is now considered viable treatment for all conditions that cause intolerable suffering, where what is deemed intolerable has no objective contours, only defined by the subjective assessment of a likely vulnerable and distressed patient. Furthermore, the suffering from a disease need not be real — simply the fear of potential suffering warrants consideration for MAID.
Instead of patients asking for MAID, as originally imagined, we now have medical regulatory colleges mandating that physicians inform patients about MAID as a treatment option, as in the case from Nova Scotia mentioned above. The College of Physicians and Surgeons of Ontario policy on Human Rights in the Provision of Health Services states that: “Physicians must provide patients with accurate, complete and unbiased information about all available and appropriate options to meet their clinical needs or concerns … Physicians must not withhold information about the existence of any relevant service, treatment or procedure because it conflicts with their conscience or religious beliefs.”
We have redefined which patients can access MAID, when they can ask for it, and what criteria qualifies them for it. Voluntary euthanasia and assisted suicide are no longer patient-driven requests; they flow from regulatory mandates that physicians must mention as available options. The slope does not seem slippery; it seems entirely new.
The right-to-die lobby spent much of the 20th century trying to normalize death. But nothing could convince the public that euthanasia was simply a “good death.” Normalizing death is hard to defend, so the plaintiff in the Carter case took a different approach. They used new language — “grievous” and “irremediable” conditions with intolerable suffering — in their criteria for “physician-assisted dying.” The lobby had found its way in. It framed the ban on assisted suicide and voluntary euthanasia as equivalent to condemning a patient to “intolerable” suffering.
Of course, this is not a medical reality. Pain can be very well-controlled, and even when it cannot, terminal sedation can eliminate conscious suffering without intending death. Nevertheless, the court accepted the bait and sided with the plaintiff, adopting their language in its ruling.
We need to revisit MAID criteria based on what patients actually experience, compared with other medical conditions. No one equates hearing loss — an irremediable and irreversible condition — with terminal cancer. We need criteria that can capture the difference and we need mechanisms to ensure criteria are followed. We need limits to MAID based on the reality of what exists, not on images conjured from the Carter case 10 years ago.
Shocking isnt it. I await being told of the option for my chronic disease, even if its just a nuisance after treatment (non hodgkins Lymphoma) I have been trying to get on the local committee supposedly assessing these patients, and am ignored. Most of the members, if not all, appear to relish the thought. Most other countries look at Canada with horror. What a great way to lighten the load on long term care. No dont redefine it. Get rid of it entirely-we functioned alright without it. So far I have had 2 patients look to me for mental illness. Per the RC I told them not an option. Does that satisfy the RC bigots, doubt it.
Great point, Dr. Dimock, about the assessment committees being full of advocates. Not sure how common this is. It’s a real issue for MAID educators, for sure.
I’d rather this was done outside of medicine.
Thanks for taking time to share a comment!
Quite agree Shawn.
Unfortunately,MAID has become a treatment option in Canada because of the inadequacy of health care imo.
A sad testament …
All of is is valid except:
It is not always that pain could be controlled- if one practices not in academia but in real life.
And, secondly, with many patients having no access to a medical doctor at all, and with palliative or any specialists even harder to come by, people feel rightly desperate. Moreover, many family doctors are not comfortable with palliative prescriptions, refusing their patient that venue – that if one even has a family doctor. Because of those purely Canadian issues, practicality of pain control becomes even more strenuous.
I know palliative cases that were not able to get opioids except going in local ER ( being driven there, sitting for hours waiting their turn, going through humiliation of proving that it was not a drug seeking behaviour) to receive a dose or two of methadone. Because there was no availability of chronic pain or palliative physicians unless they, patients, were admitted to a hospice 6 weeks before demise. And that for a patient already in pain, with mobility problems…
So, as horrible as all of the described is, Canadian health care system invites horror. You, Shawn, wrote well about that in your book. Indignity of being a patient in Canada, worse, if one’s disease includes and suffering might, leads to this horrible option- an option that any civilized country would abhor. And no, in medical sphere, Canada is firmly third world.
Powerful comment, Dr. Apel. Thank you.
Desperation sits at the centre of this discussion from all sides. We need to start from that point. Desperation, indignity … unfortunately most voters don’t want to think too much about it.
Really appreciate you taking time to post!
Exactly. You always find a way to sum everything up into one, concise point, Ram.
Great access to palliative care, including the option of terminal sedation for intractable pain, would eliminate most requests by cancer patients, I suspect. It wouldn’t change the requests made by patients who have no social services though … which is a far more concerning issue, IMO.
Thanks for posting a comment!
Sorry. Don’t agree. I am 76 and so thankful for the option of MAID. I don’t feel the situation needs to be chronic. In fact if I get diagnosed with dementia then I would like to arrange matters ahead. I have watched death of a parent and it is not true that sx are controlled. They had dementia and then a hip fracture. He died in confusion and a terribly extended period of starvation and pain. And did not get meds as nurses said he was fine. I do not want a life of dependency. My husband just had a TIAand small stroke. So yes we talked. And we are both on the same page. Pull the plug. We have had great productive lives. We are at the end. I do not want my savings spent on a nursing home. I refuse that option. Family with dementia die in front of your eyes. Over years. Same with stroke and various neurological dx. Why walk down that road if you choose not to. In the end we should have that choice. And my family support me. So far!!
Totally get it, Dr. Farquharson. I think most Canadians still support the idea of NOT blocking terminal patients from accessing physician-assisted suicide and voluntary euthanasia.
That discussion has ended, but we are still using those old assumptions. We picture desperate cases (as you describe), but today we are talking about an entirely new reality:
– patients offered MAID as they are being wheeled into surgery for treatable disease
– patients offered MAID because they can’t get a wheelchair lift installed
– people with hearing loss accessing MAID
This is where we need to pause, I think. No one imagined that these new patients were going to be on the list.
Thanks for posting!
This topic brought to mind an interview I saw several months ago. In part it describes the physical experience of the person undergoing “treatment.” Can this be confirmed from what is know about the medications and process involved in MAID?
https://youtu.be/3YYxOfwrsrU?si=PVQKTLGdVbN7r98w
Thanks for sharing this, Betty.
I haven’t watched the clip, but since it’s JBP I’ll let it stand. NOTE: I don’t always agree with Peterson, but he’s thoughtful and earnest. We need more space for voices like his.
Thank you for for your kind reply. I work in the healthcare sector but do not have medical training. Briefly, my concern stems from the interviewee’s description of the medications and physical response having similarity to being water-boarded (fluid build up in the lungs) while being paralyzed. The process in some instances can take considerable time, all the while, the person appears peaceful because of the inability to react in a visible way. Just wondering if this claim can be corroborated by yourself or another here with experience in this?
“Physicians must not withhold information about the existence of any RELEVANT SERVICE, treatment or procedure because it conflicts with their conscience or religious beliefs”
The situations that you seem to disagree with are the ones where the MAID option does not seem relevant. When MAID was originally being discussed there were supposed to be regulations put in place. Extreme pain seemed to be the first obvious situation. It seems that without regulations the slippery slope was inevitable. I have no problem with expanding the list of situations in which MAID can be an option. We need specific regulations need to be put in place. I would prefer the same criteria for the whole country.
Frankly, if if came down to all or none and I had to choose, I would allow the slippery slope instead of making people suffer in pain. I think we should find a better option.
Great point, Gerry.
I suspect you and I would only differ on the application of our libertarian tendencies. You remain fully committed to freedom as the ultimate social good. I’ve cooled a bit on that because of things such as voluntary euthanasia because of the externalities involved (eg elderly or disabled feeling that it’s their duty to die).
The “relevant service’ point is bang on. The problem is that CAMAP has pushed MAID to be a ‘relevant service’ for ANY condition that is chronic and potentially leading to death at some point. Heart disease, diabetes, and a raft of other illness now qualify for MAID.
Thanks for posting! Great comment
I am not a fan of MAID in its current form. However, I must disagree as well. Your intentions are noble, but the on the ground reality of health care in Ontario requires some sort of escape valve, even if I find it personally abhorrent.
” and a 41-year-old man receiving MAID for COVID “post-vaccination syndrome” — a debatable diagnosis.”
The diagnosis is debatable only because those physicians didn’t have access to (or refused to consider) mass spectrometry, which can not only detect elevated spike protein, but can differentiate spike protein of Covid from that of the mRNA injection.
For obvious reasons, that test is not done in Ontario. However, for those with financial means that have access to this measuring tool, I can assure you that “post vaccination syndrome” is indeed real, irreversible, and increasing in frequency. It consists of any one or combination of fibrosis, amyloidosis, immunodeficiency, and autoimmune disorders.
Line 1 retrotransposons and v(d)j recombination are indeed real and creating havoc in the mRNA injected.
These patients are increasingly debilitated and being gas lighted by their physicians. For many of them, MAID is the only way out of their misery.
As time progresses, this is going to become an increasing indication for MAID, regardless of whether these patients are accurately diagnosed or not.
David, thank you for sharing this!
I can’t take up this line of discussion — my comment was based on what my better-informed colleagues have told me. But it’s good to see you raise points for us to learn and reflect on the other side of the post-vaccination-syndrome debate.
And you make a good comment about escape valve. I think many support voluntary euthanasia as being a de facto escape valve for an overloaded system. This begs the question whether it’s the best approach to a system that cannot live up to its promises to provide care for everyone.
Thanks again!